Renal cell carcinoma (RCC) is the most common kidney cancer in adults (approximately 90%), and clear cell RCC (ccRCC) is the most frequent histologic subtype (approximately 75%). We reviewed the safety and efficacy of checkpoint inhibitors (CPIs) in ccRCC, identifying 5927 articles in PubMed, Embase, Cochrane, and Web of Science. Ten randomized control (N = 7765) and 10 non-randomized (N = 572) studies were included. Overall, 4819 patients treated with CPI combinations were compared with everolimus, sunitinib, or placebo. Overall response rates (ORR) were 9-25% with nivolumab (niv), 42% with niv + ipilimumab (ipi), 55.7% with niv + cabozantinib, 56% with niv + tivozanib vs. 5% with everolimus. ORR was 51.5-58% with avelumab + axitinib vs. 25.5% with sunitinib. ORR was 59.3-73% with pembrolizumab + tyrosine kinase inhibitor vs. 25.7% with sunitinib. ORR was 32-36% with atezolizumab + bevacizumab vs. 29-33% with sunitinib. In patients with PD-L1+ve and -ve ccRCC, niv, atezolizumab, ipi, and pembrolizumab were safe and effective alone and when combined with cabozantinib, tivozanib, axitinib, levantinib, and pegilodecakin. Atezolizumab + bevacizumab was safe and effective in ccRCC with high PD-L1 expression. Pembrolizumab was safe and effective in preventing recurrence in ccRCC patients with nephrectomy. Additional randomized, double-blind, multicenter clinical trials are needed to confirm these results.
Hematology/oncology and stem cell therapy. 2023 Apr 04*** epublish ***
Mahwish Farrukh, Muhammad Ashar Ali, Madiha Naveed, Rooma Habib, Huda Khan, Tooba Kashif, Hina Zubair, Memoona Saeed, Sigmone K Butt, Rabiya Niaz, Ishan Garg, Aqsa Fatima, Wajeeha Aiman
Sir Syed College of Medical Sciences for Girls, Karachi, Pakistan., Baqai Medical University, Karachi, Pakistan., University of Southern California, Los Angeles, CA, USA., Dow University of Health Sciences, Karachi, Pakistan., Rawalpindi Medical University, Rawalpindi, Pakistan., King Edward Medical University, Lahore, Pakistan., Fatima Jinnah Medical College, Lahore, Pakistan., Fraser Health Authority, Surrey, Canada., Allama Iqbal Medical College, Lahore, Pakistan., Saint Michael's Medical Center, New York College of Medicine, Newark, NJ, USA.